2005 SAGES Abstracts

POSTER ABSTRACTS
performed followed by division of the gastrohepatic ligament
and short gastrics with the harmonic scapel. The left gastric
artery was divided at its origin with an EndoGIA vascular stapler
and the nodal tissue resected with the specimen. A
Compat 7Fr. feeding jejunostomy was placed using the
Seldinger technique. The patient was then reintubated with a
double lumen ETT and a vertical, mini (9cm) muscle-sparing
thoracotomy was then performed. The esophagus was mobilized
to the level of the aberrent subclavian artery and the azygous
was divided. Levels #4,7,8,and 9 mediastinal lymph
nodes were dissected. Finally, an end to side, handsewn
esophagogastric anastomosis was fashioned 3-4 cm caudal to
the aberrent right subclavian artery coursing posterior to the
upper thoracic esophagus.
Results:Three patients with esophageal carcinoma were
approached with a laparoscopic Ivor Lewis esophagectomy.
Two patients had Siewert Type II T3N1 lesions, one had
Barrett’s with carcinoma in situ. One patient had neoadjuvant
chemoradiation therapy. Median age was 63 yo and median
LOS was 9 days. One patient had a barium obstipation treated
succesfully with enemas, there were no deaths. No patient had
dysphagia postoperatively secondary to the aberrent posterior
right subclavian that was left in its native position.
Conclusion: A laparoscopic Ivor lewis esophagectomy is feasible
with acceptable morbidity and LOS. In patients with gastroesophageal
junction carcinomas and an incidental aberrent
right subclavian artery posterior to the thoracic esophagus, a
laparoscopic Ivor Lewis esophagectomy appears to be a safe
approach that affords good postoperative swallowing function.
P286–Esophageal/Gastric Surgery
LAPAROSCOPIC NISSEN FUNDOPLICATION IN INFANTS LESS
THAN 10KG, Robert J Wilmoth MD, Michael E Harned
MD,David T Schindel MD,Konstantinos G Papadakis MD, East
Tenessee Children’s Hospital and The University of Tennessee
Medical Center at Knoxville, Tennessee
Introduction: Laparoscopic Nissen fundoplication is an effective
means for treating gastroesophageal reflux disease
(GERD). As it gains popularity in the pediatric population, its
widespread utility is still being defined. We present a group of
patients in whom laparoscopic Nissen fundoplication was performed
successfully in infants weighing less than 10 kg. Our
purpose is to illustrate that laparoscopic Nissen fundoplication
is a safe and effective means for treating GERD in this patient
population.
Patients and Methods: Patients undergoing an anti-reflux procedure
between June, 2001 and July, 2004 were identified.
Retrospective review was performed of both the patients?
medical record and office chart. Data was recorded with
respect to: age, weight, indications, operative time, concurrent
procedures, time to initiate feeding, post-operative length of
stay, and complications.
Results: 22 laparoscopic Nissen fundoplications were performed
in patients weighing less than 10kg. Most common
indications included GERD (N=22), associated with failure to
thrive (N=10) or respiratory symptoms (N=7). Gastrostomy
was performed in 17 patients. Pyloromyotomy was performed
concurrently for delayed gastric emptying in three patients.
Mean patient weight was 6.3kg (range 3.0 to 9.5kg). Mean
operating time was 2 hrs 50min. Mean post-operative hospital
stay of all patients was 7.2 days. There were no conversions to
an open procedure. There were no complications or recurrences
during a mean follow-up of one year.
Conclusions: Laparoscopic Nissen fundoplication is an effective
means for treating GERD in the infant population. Our
data specifically illustrates its safety and efficacy in patients
who weigh less than 10kg. As experience with this procedure
continues to evolve, its role within other populations will further
be defined.
P287–Esophageal/Gastric Surgery
EXPERIENCE WITH DEVELOPMENT AND CLINICAL USE OF A
SMALL OPENER FOR LAPAROSCOPIC ASSISTED GASTRIC
SURGERY, Hideo Yamada PhD, Juri Kondo MD,Eiji Kanehira
PhD,Masahiko Sato PhD,Kouich Nakajima PhD,Takahiro
Kinoshita PhD,Shigetaka Suzuki MD, Endoscopic Surgery
Center , Toho University Sakura Hospital
?yObjective?zOrgan extraction and anastomosis in the event of
laparoscopic assisted gastric surgery is performed in direct
view from a small opening; an instrument is needed to reinsufflate
the peritoneal cavity and perform laparoscopy again
after anastomosis is complete. Various instruments are currently
being developed, although the current situation is one
in which there are no instruments with which a sufficient
opening and laparoscopic manipulation afterwards can be
smoothly performed. Thus, the authors developed a small
opener for laparoscopically assisted surgery (Multi Flap Gate :
afterwards, MFG) intended for protection and effective opening
of the peritoneal wound and simple re-insufflation in
laparoscopic assisted gastric surgery . ?ySubjects and
Methods?zThe specifications of the MFG have been indicated.
There are four aspects: a surface ring (approx. dimensions
?Ó140 mm, height 13 mm, opening ?Ó110 mm), an intraperitoneal
ring (ext. dia. ?Ó125 mm, int. dia. ?Ó105 mm, thickness
5 mm), a draft protection sheet (length 100 mm), and a tension
belt (width 35 mm, thickness 1.5 mm); the site is opened further
by pulling the latter. Re-insufflation can be performed by
attachment of a converter (approx. dimensions ?Ó140 mm,
?Ó70 mm) to the ring. In addition, there is a small hole in the
center and it can be used as a port through insertion of a cannula
here. The MFG was used in 60 cases of laparoscopic
assisted gastric surgery March 1999 to August 2004. The
length of the skin incision was 5-9 cm.
?yResults?zThe MFG was easily attached in all cases and
retraction strength was favorable. Damage to the MFG during
surgical handling and trouble with regard to manipulation was
not seen. The shape of the opening was almost square; extraction
of organs and surgical manipulation in direct view were
favorable. Gas leaks were also not noted during re-insufflation.
In addition, no cases of postoperative wound infection or portsite
recurrence were noted. We can do stomach resection ,
anastomosis and lymph node dissection easily using MFG.
?yConclusion?zThe MFG has exceptional opening strength and
is an optimal instrument for laparoscopic assisted gastric surgery
that allows re-insufflation. A favorable surgical field was
ensured by this instrument and laparoscopic assisted gastric
surgery can be performed; it was also useful for prevention of
wound infection and cancer cell implantation.
P288–Esophageal/Gastric Surgery
PERFORATED PYLORODUODENAL ULCERS, A.A. Gulyaev, P.A.
Yartsev, G.V. Pahomova, Gastroenterology department.
Scientific research institute of emergency help named after
N.V.Sklifosovskiy. Moscow. Russia.
Methods:346 patients were treated with perforated gastroduodenal
ulcers during the period of 1999 to 2004.
Results:All patients had to take polyposition X-ray test of a
belly cavity. In case of free gas absence (50%) in a belly cavity
and a doubtful clinical picture of perforated ulcer, the gastroscopy
was the next stage in the diagnostic program.
Repeated X-ray test of a belly cavity after gastroscopy allowed
to reveal free gas in 91 % of the patients who had not have
endoscopic indications of perforated ulcer (53%). Laparoscopy
is the most effective diagnostic method in complicated cases.
At Sklifosovskiy hospital operation of a choice for patients
with perforated pyloroduodenal ulcer, without accompanying
complications of ulcer disease (a stenosis, a bleeding), is simple
closing perforation. The perforation on forward wall of
duodenal, the sizes less then 0.5sm, without expressed inflammation
and no widespread peritonitis were direct indications
for laparoscopic operation. Major cause of refusal from laparoscopic
interventions was the widespread peritonitis, a combination
of perforation and a bleeding, the big sizes of perforation
(more than 1,0sm). Closing perforated ulcer is directed at
treating complication of an ulcer disease, but does not result
in complete quire of it. In this connection these patients
require therapy of ulcer disease, since the first hours after
operation. The long term results of 67 patients have been
investigated (in terms after operation from 5 months till 3
years). To get the precise assessment of the received results
the patients have been split in two groups. Group “ A “ included
the patients observing main principles of an ulcer disease
treatment, in group “ B “ the patients who were not. The
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